Federal Employees Health Benefits Program (FEHBP): Available Health Insurance Options

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AnnieL. Mach
Analyst in Health Care Financing

FEHBPis generally available to employees, annuitants, and their dependents. Eligibleindividuals may elect coverage in an approved health benefits plan foreither individual or family coverage. For the 2013 plan year, there areabout 230 different plan choices, including all regionally availableoptions. As a practical matter, an individual’s choice of plans is oftenlimited to 10 to 15 different plans, depending on where the individualresides. While enrollees have a range of choices, they typically decidewhich options best match their needs, the amount of their wages they willcontribute to health insurance, and how risk-averse they are to potentialout-of-pocket costs.

While most federal employees or annuitants reaching age 65 are automaticallyentitled to Medicare Part A, Medicare-eligible employees may alsovoluntarily choose to enroll in Medicare Part B and Part D. Forindividuals covered under a FEHBP plan as an annuitant, Medicare is the primarypayer and FEHBP is the secondary payer. As a secondary payer, FEHBP could covera share of Medicare deductibles and coinsurance for any services that arecovered by both plans, and FEHBP would continue to reimburse for itscovered services that are not covered by Medicare.

FEHBP is administered by the Office of Personnel Management (OPM), which isstatutorily given the authority to contract with qualified carriersoffering plans and to prescribe regulations necessary to carry out thestatute, among other duties. Some of OPM’s additional duties include coordinatingthe administration of FEHBP with employing offices, managing contingencyreserve funds for the plans, and applying sanctions to health careproviders according to the prescribed regulations.


Date of Report: November 6, 2012
Number of Pages: 27
Order Number: RS21974
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